The Secret

The villages are full of AIDS orphans. Almost everybody gets malaria. The medicine is primitive, and there’s little access to anything better. There are no X-rays or ultrasounds, let alone CT scans or MRIs. People can’t afford medicines, and ambulances don’t exist. The airline has lost our bin of surgical supplies.

Uganda, 2013, a few kilometres from the Equator and the shores of Lake Victoria. We are welcomed in Kamengo by the village teens, dancing and drumming for us in the community centre. I’m part of a group of volunteers with the Canada Africa Community Health Alliance (CACHA), a non-government, non-religious organization that partners with local organizations to improve the health of rural communities. We’ve taken time off from our jobs back home and paid for the mission with personal donations. Rural healthcare is extremely basic; the arrival of our team will tremendously boost the capacity of the local clinic.

Photo: Peter Newman

Numbers

The teenagers dancing and drumming for us have all have lost a father, mother, or both to AIDS. In this country of 35 million people, there are one million AIDS orphans. Through CACHA we are sponsoring 150 of the one million, paying their school fees and more.

150 kids out of one million. I try to understand the numbers. But I just can’t picture one million orphans.

Whispers

The patient sitting in front of me is Christine, a young woman with a round face. She wears a blue and green dress with a wide sash around the waist. She looks worried. She avoids my eyes.

“Oli otya?” I ask in my primitive Luganda. How are you? 

She looks down.

“It hurts me here,” she replies quietly, through the interpreter.

She points to her lower abdomen, then to her left leg, where her pain is spreading.

“How long have you had this pain?” I ask.

My interpreter, Aisha, is a pretty 25-year-old from another village. She translates my question. Christine turns away, looks at the wall.

“How long?” I repeat gently.

“Since the family-planning operation." Her voice is barely audible.

There are many patients waiting in the room, and everybody’s symptoms are easily overheard. The Ggoli clinic is run by the Catholic diocese and staffed by nursing sisters or nuns. Here, interference with reproduction is not permitted. That doctrine is taken seriously at Ggoli. So we have been warned not to talk loudly if we give advice about contraception or sterilization. There is no privacy here.

“Three weeks,” she whispers.

Christine is 30 and has seven children. Girls here are often pregnant at 13 or 14. Pregnant because of following Catholic doctrine forbidding contraception, while selectively ignoring the prohibition of premarital sex. I question her further. Through Aisha, she tells me that her tubal ligation was done by an itinerant practitioner who advertises his services. He is not a doctor. His qualifications are unknown.

I look at her abdominal wound. It is red, swollen, and warm. Green pus oozes from the incision. I do a gynecological examination and find she also has a serious, internal pelvic infection. The operation has been done crudely.

I prescribe an antibiotic and pain medication, and add an HIV test; maybe the amateur surgeon’s instruments weren’t sterilized.

She is weak and sick from her secret procedure, but she looks frightened, too. She needs me to do more than give her medicine.

I lean forward to look in her eyes, and speak so that others in the crowded room don’t hear.

“You’re 30, and you have seven children?” I keep my voice very low.

Christine nods. She meets my gaze now.

I glance around the room, check that nobody’s eavesdropping.

“You have done the right thing,” I say.

Her eyes open wide in surprise. 

“Where I come from, many women have this operation after they’ve had only two children.” 

When I talk with the villagers, their faces usually remain impassive, out of respect. Now, however, I see astonishment on hers. Then, a timid smile. 

She gets up to leave, looks at me.

“Webale,” she whispers. Thank you.

13 out of 100

When the last patient has left, I tell this story to Emmanuel, the young clinical officer. There are no physicians in this region; all the diagnosing and treating of patients is done by clinical officers like Emmanuel, with two years of post-secondary training. I come to the part about how many Westerners get themselves “fixed” with tubal ligations or vasectomies, after having only two children.

He looks shocked. “Two children?”

I nod.

His voice rises. “How can they do that?”

I try to explain how many people think in the wealthy First World. Having fewer children preserves family resources, can allow a better life for both the children and the parents. Emmanuel is frowning.

“You know, in this Mpigi District, 10-15 households share one toilet.”

I work to imagine this. A toilet for every 10 or 15 households. Hard to visualize.

He goes on. “Of every thousand children, 130 die before they reach the age of five.”

The low hum of the fan stops as the power goes out. Electricity is unreliable here. From another room I hear the voices of the volunteers, putting away the day’s supplies.

“That’s 13 of every 100 children,” he continues. “They die of infections— malaria, pneumonia, and diarrhea. Also from AIDS. They die from malnutrition, too.” He looks at me to see if he is getting through.

“You need to have enough children so that enough will survive to care for you when you're old,” he says.

I nod.

“So you understand? Having seven babies makes sense.”

Family: the ultimate social welfare system. The only reliable old-age insurance. Sadly, I understand.

But I think, Are Christine’s seven children not enough for a 30-year-old? Her self-appointed “surgeon” was a godsend. Thank God she survived him. I hope the next woman who needs him survives, too.

---

The names of the people in this story have been changed to protect their privacy.